Securing an indwelling urinary catheter to the leg is necessary to prevent complications. The primary purpose of securement is to eliminate tension and tugging where the catheter enters the body, minimizing the risk of trauma to the urethra or the suprapubic insertion site. Unsecured tubing can cause urethral erosion, discomfort, pain, and bladder spasms. Stabilizing the catheter also significantly reduces movement, which minimizes the risk of bacteria entering the bladder and causing a catheter-associated urinary tract infection (CAUTI).
Available Securement Devices
The market offers commercial products designed to anchor catheter tubing securely and comfortably to the skin or leg. These devices generally fall into two main categories: adhesive-based stabilizers and soft fabric straps. Adhesive securement devices, such as catheter holders, use a skin-friendly base pad that sticks to the skin, often on the thigh, and incorporates a clip or locking mechanism to hold the tubing. While favored for their strong hold, they require careful application and removal to protect the skin.
Non-adhesive options include soft fabric leg straps or bands, which wrap around the leg and secure the catheter with hook-and-loop closures or Velcro tabs. These straps allow for quick adjustment and removal, making them a good alternative for individuals with sensitive skin or adhesive allergies. Some devices are designed as full sleeves that cover the entire leg bag and tubing, offering a discreet solution that minimizes direct skin contact. All stabilization devices are designed to keep the catheter steady, reduce pulling, and improve patient mobility.
Proper Placement and Tubing Management
Selecting the correct securement site is important; the upper thigh is a common location, though securing to the abdomen is also an option. The device must anchor the tubing without causing tension during normal rest and activity. For long-term users, it is recommended to rotate the securement site every few days to prevent localized skin irritation and breakdown from constant pressure or adhesive exposure.
Before applying an adhesive device, the skin at the chosen site should be clean and dry to ensure optimal adhesion. A skin preparation product can be used to create a protective barrier, helping the device stick better and protecting the skin from the adhesive. Once the securement device is in place, the most important technical detail is creating a slight curve, or “slack loop,” in the tubing between the insertion site and the anchor point. This slack loop acts as a buffer, ensuring that any accidental tug or movement is absorbed by the tubing loop and not transferred as tension to the urethral meatus or suprapubic site.
The slack loop should be approximately one inch long, allowing for slight movement without pulling the catheter. When using a leg strap, the catheter is laid onto the device and the securing tab is wrapped over the tubing. The fit must be secure enough to prevent slipping but not so tight that it compresses the tube and blocks urine flow. The securement device should be checked periodically to confirm it remains properly positioned and that the tubing is not kinked or twisted, which could obstruct drainage. Monitoring the skin daily under the device is also necessary to assess for signs of redness, erosion, or discomfort.
Ensuring Secure Drainage Bag Positioning
Securing the catheter tubing is only one part of the system; the drainage bag must also be managed correctly to ensure function and prevent complications. The drainage bag, whether a smaller leg bag used during the day or a larger night bag, must always be positioned below the level of the bladder. This positioning uses gravity to aid continuous urine flow and prevents the backflow of contaminated urine, which reduces infection risk.
Daytime leg bags, which typically hold between 500 and 1000 milliliters, are secured to the calf just below the knee using straps or a securement sleeve. This placement keeps the bag discreet and allows for proper drainage while the individual is sitting or standing. The straps must be snug enough to prevent the bag from swinging or pulling on the catheter connection, but they should never be so tight that they impede circulation.
For overnight use, a larger drainage bag, often holding 2000 milliliters, is connected to the system. This bag should be hung from a secure stand or the bed frame, ensuring it never rests directly on the floor, which can introduce bacteria. It is important to ensure that the tubing leading to the night bag is not kinked, twisted, or trapped beneath a limb, as any obstruction will prevent proper drainage and cause discomfort. A secure connection and proper positioning are necessary to maintain the integrity of the entire closed drainage system.